You’ve just finished having sex with your partner, when you look down and see blood on the sheets. You don’t have your period and aren’t supposed to get it anytime soon, so what gives?

While vaginal bleeding after sex can be scary, it’s also fairly common. It affects up to 9% of menstruating women. There’s probably no cause for concern. But it can also result from an infection. In rare cases, it's a sign of cervical cancer.

Causes of Bleeding After Sex

The most common causes for vaginal bleeding after sex both start in the cervix, which is the narrow, tube-like end of your uterus that opens into the vagina.

One of those causes is cervical inflammation, or cervicitis. It can be ongoing and totally harmless, or it can happen because of a sexually transmitted infection that you need to get treated, like chlamydia or gonorrhea. Both types of cervical inflammation can cause bleeding after sex.

A second common reason for bleeding after sex is cervical polyps. These growths are usually small -- about 1 to 2 centimeters. They often appear on the opening of your cervix. Most aren’t cancerous. Your doctor can remove them during an appointment.

Other causes of vaginal bleeding after sex include:

• Friction during sex or not enough lubrication
• Normal uterine bleeding if you're just beginning your period or if it’s just ended
• A cervical or vaginal infection
• Genital sores caused by herpes or another condition
• A precancerous cervical spot
• Cervical ectropion (when the inner lining of the cervix pokes through the cervical opening and grows on the vaginal side of the cervix)
• Pelvic organ prolapse (when pelvic organs, like the bladder or uterus, protrude or fall just beyond the vaginal walls)
• Cancer of the cervix, vagina, or uterus

Dryness caused by these things can also lead to vaginal bleeding:

• Breastfeeding
• Childbirth
• Some cold, allergy, and anti-estrogen medications
• Cancer therapy and its effect on your ovaries
• Douching
• Sjögren’s syndrome
• Menopause

While many of these causes don’t need treatment and are harmless, sometimes vaginal bleeding after sex can be a sign of a more serious problem.

Risk Factors for Bleeding After Sex

You may have a higher chance of bleeding after sex if you:

• Have cancer of the cervix, vagina, or uterus
• Are going through menopause or perimenopause (the transition to menopause)
• Had a baby not long ago or are breastfeeding
• Aren’t fully aroused before vaginal penetration
• Use douche products 
• Have an infected cervix
• Have a sexually transmitted disease or sexually transmitted infection

Is Bleeding After Sex Serious?

If you have some minor bleeding every once in a while, chances are everything is fine. But the only way to know for sure is to see your doctor for a physical exam.

If the bleeding happens right before you get your period or within a few days after it ends and it doesn’t happen again, you can hold off on making that appointment. You can also probably hold off if you recently had a pelvic exam and Pap smear and got a clean bill of health. In all other cases -- or if you’re just worried -- it’s best to get checked out to rule out infection or anything more serious.

Bleeding After Sex and Menopause

If you’re postmenopausal, any bleeding after sex isn’t normal. See your doctor to rule out cervical cancer, endometrial cancer, and other issues.

Bleeding After Sex and Pregnancy

Vaginal bleeding after sex can be scary if you’re pregnant, but it probably isn’t a cause for concern. Your cervix may bleed more easily during pregnancy because extra blood vessels are developing in the area.

Bleeding After Sex Diagnosis

Your doctor’s first step will probably be to ask you some questions to see if there’s an obvious cause for the bleeding, like breakthrough bleeding after you just start to take a birth control pill.

They’ll also want to know if you’re having pain during sex, which can be a sign of dryness or infection, depending on when it happens.

The doctor will give you a pelvic exam and look for any source of the bleeding, like vaginal tears or lesions, signs of pelvic organ prolapse, cervical polyps, or inflammation. If you have polyps, they might be able to remove them in the office and send them to a lab for testing. Or you might need a later appointment to have them surgically removed. You could also get a:

• Pregnancy test
• Cervix exam with a tool called a speculum
• Colposcopy
• Transvaginal ultrasound
• Pap test
• Test for a sexually transmitted disease or sexually transmitted infection

During a Pap test, the doctor can swab your cervix to test for any sign of abnormal, precancerous growths or cancer cells. But they will also use the test to check for any sexually transmitted infections like chlamydia and gonorrhea, which can cause bleeding after sex and are treated with antibiotics. 

Abnormal Results

If the Pap test reveals any problems with your cervix at the time of your exam, you’ll probably get a colposcopy. It starts out like a Pap test but takes a bit longer. The doctor will use a special magnifying device called a colposcope to get a closer look at the cervix. If they see anything suspicious, they can take a small sample of tissue for testing.

If bleeding after sex is an ongoing thing, the doctor may recommend a colposcopy even if your Pap test results are normal, to get a better look at your cervix.

If you’re postmenopausal, the doctor might do a transvaginal ultrasound to get a closer look at your pelvic organs. They might also do an endometrial biopsy to check for abnormal cells in the endometrial tissue that lines your uterus.

Treatment for Bleeding After Sex

Since there’s no one cause of bleeding after sex, there’s no single treatment. Some options include:

• Vaginal lubricants and moisturizers
• Medication for sexually transmitted infections
• Estrogen therapy
• Cervical cancer treatment (surgery, chemotherapy, or radiation)
• Polyp removal

Can Bleeding After Sex Stop on Its Own?

It might. A recent study found that just over half of women who had bleeding after sex reported that it cleared up on its own within 2 years.

Preventing Bleeding After Sex

You can make some lifestyle changes to lower your risk of bleeding after sex:

• Use a lubricant before and during sex
• Wait a bit longer after your period ends to start having sex again.
• Have your doctor remove any cervical polyps or treat cervical infections.
• Have more foreplay before penetration
• Try less aggressive sex